Caso Clínico Pleural, Ejercicios de Fisiopatología

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CASE 45 A 32-year-old woman presents to the emergency room complaining of productive cough, fever, and chest pain for 4 days. She was seen 2 days ago in her primary care physician's clinic with the same complaints, was diagnosed clinically with pneumonia, and was sent home with oral azithromycin. Since then, her cough has diminished in quantity. However, the fever has not abated, and she still expe- riences left-sided chest pain, which is worse when she coughs or takes a deep breath. In addition, she has started to feel short of breath when she walks around the house. She has no other medical history. She does not smoke and has no his- tory of occupational exposure. She has not traveled outside of the United States and has no sick contacts. On physical examination, her temperature is 103.4*F, heart rate 116 bpm, blood pressure 128/69 mm Hg, respiratory rate 24 breaths per minute and shallow, and pulse oximetry 94% saturation on room air. Physical examination is significant for decreased breath sounds in the lower half of the left lung fields posteriorly, with dullness to percussion about halfway up. There are a few inspiratory crackles in the mid-lung fields, and her right side is clear to auscultation. Her heart is tachy- cardic but regular with no murmurs. She has no cyanosis. Figure 45-1 shows her chest x-ray films. » Whats your most likely diagnosis? » Whatis your next step?